Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems

Abstract

Financial toxicity is a side effect of cancer that results from the perceived financial distress an individual may experience in the course of the disease. The purpose of this paper is to analyse underlying factors related to subjective financial distress in high-income countries with universal healthcare coverage. A systematic literature review was conducted to identify qualitative and quantitative studies of cancer patient-reported subjective financial distress by performing a search in the databases of PubMed, PsycINFO and CINAHL up to December 2020. A qualitative synthesis was performed linking the time-dependent occurrence of risk factors to derived categories of risk factors. Out of 4321 identified records, 30 quantitative and 16 qualitative studies were eligible. Classification of risk factors resulted in eight categories with a total of 34 subcategories. Subjective financial distress is primarily determined by pre-diagnosis sociodemographic- factors as well as financial and work factors that might change during the course of the disease. The design of healthcare and social security systems shapes the country-specific degree of subjective financial distress. Further research should focus on evolving multidisciplinary intervention schemes and multidimensional instruments for subjective financial distress to account for identified risk factors in universal healthcare systems more precisely.

Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis

“…Similarly, there is limited knowledge when it comes to measuring subjective financial toxicity and included studies scarcely focused on it. This finding confirms previous observation that there is a lack of accepted definition of subjective financial toxicity [ 55 ].…”

Reduction in Standard Cancer Screening in 2020 throughout the U.S.

“…These issues are likely to create greater disparities. Financial toxicity in the U.S. among cancer patients may range as high as 39–64%, however, it is only 7–39% in publicly funded health care systems that target underserved populations [ 32 , 33 , 34 ]. Lower financial toxicity for those using publicly funded health care systems may help prevent some increases in disparities due to COVID-19.…”

A systematic review of financial toxicity among cancer patients in China

“…6 FT in cancer patients has been studied extensively in both developed and developing countries. [7][8][9][10][11][12][13][14][15][16][17] A systematic review 7 developed a conceptual framework involving 3 domains of FT measures: material condition measures (eg, OOP costs, indirect costs, medical debts, asset depletion, and bankruptcy), psychological response measures (eg, distress and concerns due to cancer care costs and income loss), and coping behavioral measures (eg, taking less medication and/or forgoing care because of costs). Other systematic reviews have reported that 28% to 48% and 16% to 73% of cancer patients experience monetary and subjective forms of FT, respectively, 8 and that the FT prevalence ranges from 15% to 79%.…”